Value of future adherence

ABSTRACT

The present technology calculates a value of future adherence (VFA) score which is a patient-level, predicted, expected cost of conversion from non-adherence to adherence over a specified time-frame. The score consists of three general components: (1) probability of being non-adherent, (2) cost reduction associated with being adherent, and (3) probability of converting from non-adherent to adherent. These values can be combined to create an overall VFA score. A user interface is then provided which shows at least a list of patients and information related to the VFA score.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/519,557 filed Oct. 21, 2014 which claims priority to U.S. PatentApplication No. 61/893,750 filed Oct. 21, 2013. The entire contents ofeach of these applications are incorporated herein by reference.

BACKGROUND AND SUMMARY

The health care profession is rapidly changing. We now live in a timewhere health care has become a daily discussion for most media outlets.It is now more important than ever for health care providers, healthinsurance companies, and health care facilities to understand the costsassociated with each patient and the patient's adherence (ornon-adherence) to a treatment program.

Health care has become an increasingly popular topic these days,especially in light of recent legislation enabling the public greateraccess to health care. Certain technology has enabled health careproviders the ability to monitor the adherence level for each patient toa particular health care therapy (e.g., adherence to a drug regimen),and use such data to advance the practice of the particular health careprovider. Certain techniques are described in related U.S. applicationSer. Nos. 13/729,817 and 14/319,450, each of which are incorporatedherein by reference.

Conventional technology related to monitoring adherence to a particularhealth care regimen is helpful in that it can convey how involved apatient is when participating in a particular therapy. However, suchtechnology does not necessarily convey to a health care provider theactual value associated with potential future adherence to a particulartherapy. In particular, such technology does not create a metric forconveying to a health care provider the probability related a patientfor the adherence (or non-adherence) to a therapy taking into accountthe probability of the patient converting to being adherent (e.g., frombeing non-adherent) and the potential cost reduction associated withbecoming adherent.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a non-limiting example user interface;

FIG. 2 shows a non-limiting example user interface;

FIG. 3 is an illustrative table showing scores and values;

FIGS. 4A-D show illustrative flowcharts;

FIG. 5 is an illustrative block diagram showing elements of an exampleembodiment;

FIG. 6 shows an illustrative block diagram of an example setup procedurein accordance with an example embodiment;

FIG. 7 is an illustrative block diagram of a value of future adherenceengine; and

FIG. 8 shows an illustrative schematic block diagram of elements of acomputing system that may be used to perform functions associated withan example embodiment.

DETAILED DESCRIPTION OF THE TECHNOLOGY

The present technology relates to health care and health care dataanalytics. The technology estimates the total opportunity of costavoidance for a patient population resulting from non-adherence andcreates the means for prioritizing patients based on their individualValue of Future Adherence (VFA) score. The technology furtherfacilitates efficient population-level improvements in medicationadherence and other health care outcomes.

The technology relates to analytics platform having an iterative dataprocess comprising a) prediction, b) patient selection/prioritization,c) and evaluation analytics to continuously optimize performance onmedication quality indicators at a population level, includingmedication adherence. The technology uses patients' predicted futuremedication outcomes, other patient characteristics derived from patientdata, and intervention capacity attributes to compute the mostcost-effective intervention recommendation for each individual patienton a recurring basis based on accumulating data.

Conventional technology is capable of calculating cost differencesbetween an adherent population and a non-adherent population. Forexample, there exists a methodology where static, population-level costdifferences are multiplied by prevalence of disease figures to estimatea population-level opportunity cost. But the technology considers costestimates only and not patient-level probabilities of non-adherence orthe likelihood of conversion from non-adherence to adherence. As such,overall population-level estimates are highly inaccurate/over-statedand, importantly, there is no differentiation at the patient-level.Patient-level cost differentiation facilitates comparisons to be made tointervention costs allowing for strategic targeting. Furthermore, manyof the conventional systems fail to provide any metric for measuring thevalue associated with a patient's future adherence to a treatment plan.Thus, there is a need for a system that can determine such patient-levelcost differentiation taking into account the drawbacks of the presenttechnology.

The present technology calculates a VFA score which is a patient-level,predicted, expected cost of conversion from non-adherence to adherenceover a specified time-frame. The score consists of some generalcomponents including, but not limited to: (1) probability of beingnon-adherent, (2) cost reduction associated with being adherent, and (3)probability of converting from non-adherent to adherent. In particular,the score takes into account the probability that a patient will benon-adherent to a therapy, a probability that the patient will convertto becoming adherent, and a cost value associated with the costreduction from being adherent as opposed to being non-adherent. The VFAscore thus provides a metric for a health care provider, for example, todetermine the most cost-effective intervention recommendation for eachindividual patient (particularly on a recurring basis based onaccumulating data). Thus, patients VFA scores can be conveyed to ahealth care provider (e.g., via a user interface) in order for theprovider to accurately determine the value associated with recommendingintervention for a patient (e.g., to help the patient become moreadherent to a therapy).

In determining the VFA, the cost component for each patient may becalculated (1) using data elements available at the time of predictionon pharmacy administrative claims data to select a figure from apre-calculated cost table and/or (2) using medical claims to forecastpatient-level cost. The pre-calculated cost table is a table of costdifferences between a population adherent to a particular therapy area(class of drugs) or disease-state set of drugs, and a non-adherentpopulation. The table is stratified by characteristics that areavailable on pharmacy administrative claims data so that values found ona claim may be used to select, or ‘look up,’ a cost value in the tableparticular to each stratification.

As a non-limiting example, the table can be constructed by consideringany demographic or clinical characteristics that are available onpharmacy claims data as stratification variables. Each potentialstratification variable (or combination of variables) is tested anddynamically selected via a series of cost models. The stratificationselected for a therapy area is the set of variables that exhibits thebest combination of strong interaction effect and small standard errors.This combination provides information for the cost table that yields thebest cost forecasts. The table may be constructed from an existingdataset of medical administrative claims data or derived from, andtherefore customized to, a client's medical claims dataset. This allowsfor more accurate cost component estimates even when medical data arenot available.

The probability of converting from non-adherent to adherent may be setaccording to scenario testing. For example, a conservative probabilitywould be 5% where an extreme probability would be 100%. The probabilityof converting from non-adherent to adherent may also be set throughfactors related to the probability of non-adherence component of the VFAscore. Such scores reflect different behaviors, or the likelihood, oftransitioning from a non-adherent state to an adherent state.

The VFA score can be calculated by multiplying the three components. Itshould be appreciated that the score can combine the components in anymathematical fashion and is not limited to only multiplying thecomponents together. The calculated VFA score can serve as a metric forconveying (e.g., to a health care provider) the value associated withpotential future adherence to a selected therapy.

The technology described herein can be used to create both amember-level and population-level estimate of cost avoidance due tonon-adherence. Population estimates created with the VFA score are moreaccurate than methods that do not account for likelihood of beingnon-adherent in future or the likelihood of conversion from non-adherentto adherent. Further, patient-level estimates allow for strategicintervention targeting which is not possible with staticpopulation-level cost differences. Finally, each component of the VFAscore includes at least a probability of being non-adherent, a costreduction associated with being adherent, and a probability ofconverting from non-adherent to adherent is calculated using asophisticated approach, yielding the best known estimates.

FIG. 1 shows a non-limiting example user interface for a system that canconvey the VFA score for each patient for a particular practice. FIG. 1shows general “welcome” information for introducing the user to thesystem. The user can select one or more practices to view their patientpopulation based on practice ID PRID. In this example, the John SmithMedical Group is selected to view the relevant patient population aswell as the VFA score associated with each patient.

FIG. 2 shows an example interface for displaying a list of patients withtheir associated therapies where each patient is shown with theirmedication adherence PMA, VFA Score VFA, and Intervention RecommendationIR. The interface shows the patients for a particular practitioner PRIDwhere each patient is listed with a patient identification PID (e.g.,the patient's first and last name) The patient ID can also include thepatient's date of birth as well as any other particular identificationinformation for the patient (e.g., social security number, insurance ID,driver's license number).

In the example shown in FIG. 2, each patient ID is listed inalphabetical order based on the name of the patient. For each patient,the interface can show the patient medication adherence PMA, a VFA ScoreVFA, and/or an Intervention Recommendation IR for each patient PID. Thepatient medication adherence PMA shows how adherent a patient is to atherapy for treating a particular condition. That is, the PMA is avariable showing recent history that can have an impact on the overalladherence score for the patient. For example, patient “Jane Armstrong”is shown having a health condition ID CID of “blood pressure” in whichthe patient is taking a certain drug regimen to treat the blood pressurecondition. The interface can show the days past (or days until) the nextrefill date RD. In this example, 5 days have passed between the currentdate and the date that “Jane Armstrong” prescription should have beenrefilled. For example, “Jane Armstrong” may have had a next refill dateof May 1, 2014 where the current date could be May 6, 2014.

The display can also be adjusted so that the patients are prioritizedand/or ordered based on the number of medications/therapies they areengaged. For example, “Mike Armstrong” could be listed at the top as hehas multiple therapies (e.g., blood pressure and cholesterol). Thesystem could also eliminate practices that do not have a high enoughpatient participation number.

As discussed above, many systems that monitor therapy adherence forpatients of a particular practice lack the ability to convey aneasy-to-understand metric for determining the value associated withrecommending intervention for a patient. While certain technologies canshow the score related to the probability of a patient being adherent,or show the cost associated when the patient becomes adherent, thesesystems fail to provide a useful metric for assigning a value to theadherence of a particular patient. For example, in certain instances, apatient may have a relatively high cost reduction associated withadherence, yet the probability of converting the patient to beingadherent may be extremely low. Likewise, a patient may have a relativelyaverage cost reduction associated with adherence, but have a higherprobability of converting from non-adherence to adherence. Thus, the VFAscore provides a metric for enabling a party (e.g., a health careprovider) to understand the overall value associated with a patient'sadherence, especially for determining if it is worthwhile for theprovider to recommend intervention. For example, the VFA score canquantify the combination of (a) the probability that a patient will notbe adherent, (b) a probability of converting a patient from non-adherentto adherent, and (c) a cost reduction associated when converted. Thisscore provides an easy-to-understand value showing which patients wouldbe the most valuable in recommending intervention. This can be usefulespecially for providers that have a large patient population and cannotspend the time and/or resources involved in recommending or conductinginterventions for each patient.

In the example shown in FIG. 2, the VFA score for each patient is shownand, based on the VFA score, an Intervention Recommendation IR forsuggesting whether it would be worthwhile for the provider to suggestintervention. In the example shown in FIG. 2, both Mike Armstrong andJohn Armstrong have indicators showing a recommendation for interventionas both patients have relatively higher VFA scores at $93.30 and $97.40,respectively. The system can apply a variety of factors in determiningwhether intervention should be recommended. For example, a thresholdcould be established recommending intervention when a patient's VFAexceeds a certain value (e.g., $90.00). Likewise, the system could beconfigured to select a certain percentage of patients with the highestVFA score compared to other patients. Of course, these examples arenon-limiting and a variety of different factors and techniques can beused in determining whether to recommend intervention.

As discussed above, the VFA score conveys to a user the associated valuerelated to the most cost-effective intervention recommendation for eachindividual patient. For example, Jane Armstrong has a relatively highVFA score of $85.70. This could reflect that Jane Armstrong has a highcost reduction associated with converting from being non-adherent toadherent. Likewise, the score could also reflect that Jane Armstrong hasa relatively higher probability of conversion. The score could alsoreflect that Jane Armstrong has a higher probability of beingnon-adherent. The VFA score helps make such factors more transparent byproviding an easy-to-understand metric for determining the associatedvalue with a recommended intervention. Thus, a user (or health careprovider) would understand that the associated VFA score of $85.70 withJane Armstrong shows that the value associated with intervention may berelatively higher than other patients. The interface shown in FIG. 2thus advantageously conveys the VFA score for each patient so that auser/provider can determine which patients would be more valuable inrecommending interventions compared to others.

It should be appreciated that the interface shown in FIG. 2 isnon-limiting and can include any variety of additional components. Forexample, the display could be modified to show the cost associated withperforming an intervention. Such information would be useful inbalancing the cost against a particular VFA score. For example, if JaneArmstrong has a $100 cost associated with intervention, a provider wouldbe unlikely to recommend intervention as it would not even cover the VFAscore of $85.70. That is, the value associated with intervention wouldbe less than the overall cost involved in the intervention. Of course,this example is non-limiting and the display in FIG. 2 could be modifiedto show a variety of different components.

It should also be appreciated that the VFA score for each patient couldbe used to guide a user to an appropriate intervention for a particularpatient. That is, a user could have a variety of intervention optionsavailable to them including, but not limited to, a call center, sendinga letter, sending a text message, sending an email, and/or generating anautomated voice call. The VFA score could be used to weigh the value ofthe intervention against the cost of a particular intervention. Forexample, a patient could have a VFA score of $95 for a particulartherapy where five intervention options may be available. Oneintervention may cost $75 where the other four interventions may cost$100. Thus, a user could select the intervention costing $75 as that isthe only intervention below the value of the score thereby giving theuser one clear intervention choice.

The VFA score could be used to balance the cost of intervention selectedagainst the value of intervention. That is, by sorting an individual bythe VFA score, the user has the ability to select the population that isappropriate for adherence intervention. Thus, the user can weighdifferent factors in selecting a particular intervention, including thecost of the intervention and the overall effectiveness. As such,although some interventions may have higher costs than others, showingthe cost of the intervention relative to the VFA score may incentivizethe user to select a higher costing intervention as the likelihood ofthe intervention will have a better chance of the patient becomingadherent. That is, the VFA score overall blends several characteristicsthat make it easier for a user to compare costs (e.g., relative to thecost of a particular intervention).

A user may also have a total budget for interventions that may also beshown to the user via the display. When an intervention is selected, theoverall budget may be reduced by the selected intervention. Thus thesystem could advantageously allow the user to choose the most costeffective interventions while knowing their available budget.

It should be appreciated that the display shown in FIG. 2, for example,could be modified to show the different options available forintervention. Likewise, the display could additionally show the costassociated with each particular intervention so that a user can bestunderstand which interventions will be most cost effective relative tothe value of the intervention (e.g., as shown in the VFA score). Thisinformation could be displayed in an extra column, shown as a pop-upbox, or displayed via some selectable item (e.g., radio button,drop-down menu, check box). By displaying the cost associated with theintervention in combination with the patient's VFA score, the user caneffectively “draw a line” when it comes to investing in a particularintervention. That is, the user can demarcate which intervention optionswould be too costly (or not effective) with options that would be mostcost effective.

FIG. 3 is an illustrative table 1 showing the VFA score and valuesassociated with calculating the VFA score for each patient. The table 1can be displayed on a display and can be integrated for use with a userinterface. In the table 1, the VFA score for each patient can becalculated. For example, each patient could be associated with a patientID PID where several pieces of information including, but not limitedto, the name, gender, and/or other demographic information areassociated with the patient.

In the example shown in FIG. 3, the table 1 contains a list of patientswith patient ID PID, the patient name, the respective patient'sprobability of non-adherence, probability of converting from beingnon-adherent to adherent, the cost reduction associated when the patientis adherent (e.g., the cost of being non-adherent minus the cost ofbeing adherent), and the resultant VFA score associated with thesevariables. Although the example interface shown in FIG. 2 displays onlythe VFA score, the interface could also be modified to include at leastthe information provided in table 1. Such information could providefurther details as to the exact variables used to calculate the VFAscore.

As can be seen in this example, John Armstrong has a higher VFA scoredue to a higher probability of conversion even though his cost reductionassociated with adherence is lower than the other displayed patients.Likewise, Joan Bradsher has a lower VFA score than Jane Armstrong eventhough both patients have relatively similar cost reductions associatedwith being adherent and the same probability of conversion. This is due,in part, to Joan Bradsher having a lower probability of beingnon-adherent than Jane Armstrong. As a non-limiting example, such alower probability could be indicative of Joan Bradsher being more likelyto adhere to a particular therapy than Jane Armstrong thus resulting ina lower VFA score. That is, the lower VFA score tells a user that itwould be less beneficial to attempt intervention with Joan Bradsher whencompared to Jane Armstrong because Joan Bradsher would potentially havea higher likelihood of becoming adherent on her own.

FIGS. 4A-D show illustrative flowcharts for deriving a value of futureadherence. The system begins by identifying a list of one or morepatients for calculating a value of future adherence (S1). This list canbe determined using one or more pre-periods that include claims data(e.g., health care claims data) in each period. For example, a firstpre-period (pre-period 1) could be reflective of the health history of apatient starting from today and going back 90 days (e.g., the last 3months of health history from the current date). A second pre-period(pre-period 2) could be reflective of any time outside of the past 90day window including, but not limited to, all health care claim historybeyond 90 days. For identifying members on a particular therapy thesystem uses, as a non-limiting example, the health care related claimsfrom pre-period 2 (e.g., outside of the last 90 days). Candidates with aclaim for a therapy of interest are considered on a therapy and arecandidates for a VFA score.

Upon creating the list of patients, the system can obtain/calculate aprobability score of non-adherence for each patient (S2). Theprobability score could be the probability of non-adherence for aparticular patient. For example, a patient could have a probably scoreof 45 which could indicate that there is a 45% chance the patient willnot be adherent to their medical treatment, which could include takingmedications.

FIG. 4b shows further details regarding the calculation involved indetermining the probability of non-adherence. The system can firstidentify health care claims in the relevant time period (S6). In thisexample, the health care claims for determining the probability ofnon-adherence can be taken from claims in pre-period 1 (e.g., the claimswithin the last 90 days). The system then computes variables related tothe therapies as well as any relevant demographic variables (S7). Forexample, variables related to a therapy of interest, variables relatedto other therapies (e.g., peripheral therapies), and demographicvariables regarding the candidate/patient can be computed. Thisinformation is combined with a predictive model to determine the overallprobability of non-adherence for a particular candidate/patient (S8).

Upon calculating the probability score for each patient, the system canthen determine the probability of converting a patient from beingnon-adherent to adherent (S3). FIG. 4c describes a non-limiting flow ofprocesses for determining the probability of converting a patient fromnon-adherence to adherence. The system can identify the health careclaims in a relevant time period (S9) which, in this example, would bepre-period 1. Upon determining the therapy claims for the patient, thesystem can create a profile for each member based on relevantcharacteristics determined from evaluation experience (S10). Forexample, the system could use information and results from previousoutreach research (e.g., evaluation of outreach effectiveness) increating the profile. Of course, it should be appreciated that otherfactors may be used (e.g., age, gender, acuity) as well as other modelsto determine the probability of conversion, and the rate may vary by anoutreach type. The system can assign a conversion rate to each member intheir respective profile and look up the conversion rate using theassociated profile (S11). The result will be a rate of conversion foreach candidate/patient that can be used as a component for calculatingthe VFA score.

The system can analyze the medical condition and/or medical history ofthe patient to help determine factors in calculating the cost reductionvalue associated with the patient becoming adherent as opposed to beingnon-adherent (S4). FIG. 4d shows a non-limiting example flow ofprocesses for determining the cost reduction associated with beingadherent. The system can again identify health care claims for a patientwithin a relevant time period (S12) which, in this example, are claimsin pre-period 1. The system can then create (or update) a profile forthe patient based on relevant characteristics (e.g., found on healthcare/drug claims data) (S13). The profile could be created/modifiedbased on various research and modeling factors. Upon creating/modifyingthe profile, the system can determine and assign a cost reduction toeach candidate and reference such information by using the profile ofthe candidate (S14). The cost reduction could be calculated bysubtracting the cost of adherence from the cost of non-adherence (orsome other statistical method could be employed). That is, the systemcan determine the cost associated with being non-adherent and thensubtract the cost associated with being adherent for a particularcandidate. This value would yield the overall cost associated withconverting from being non-adherent to adherent.

Upon determining (a) the probability of being non-adherent, (b) theprobability of converting from non-adherence to adherence, and (c) thecost reduction associated with adherence, the system can calculate theVFA score for each candidate/patient (S5). As a non-limiting example,these factors will be combined in some fashion (e.g., mathematicallycombined) to yield the VFA score. For example, the factors can bemultiplied together to yield the VFA score for each patient/candidate.Using the example of Jane Armstrong in FIG. 3, the probability ofnon-adherence (0.7233) is multiplied by the probability of conversion(0.050) which is then multiplied by the cost reduction associated withadherence ($2,371.00) yielding the VFA score of $85.70. As explainedabove, the VFA score will advantageously reflect the overall value inrecommending an intervention for a particular patient.

FIG. 5 is an illustrative block diagram showing elements of an exampleembodiment. The basic elements 10 are described very generally withrespect to FIG. 5 and will be described in further detail below withrespect to the remaining drawings. The system includes, for example,candidate patient data 100, which is processed as described herein andprovided to a prediction engine 200. The prediction engine 200 isdeveloped as described below and includes development of a predictionfunction which is based, at least in part, on an analysis of historicalpatient data 150 which may include historical data on interventionperformance (for example, and without limitation, tracking data). Whenthe prediction function of the prediction engine 200 is applied to thecandidate patient data 100, a tailored patient-specific score is outputand can be provided to a value of future adherence engine 300.

FIG. 6 shows an illustrative block diagram of an example setup procedureused to define a prediction function in accordance with an exampleembodiment. As illustrated in FIG. 6, historical patient data 210, whichmay be in the form of a retrospective data file (or multiple files) fromthe implementation entity or program sponsor, is provided. Data in thesefiles may include, for example, demographic, survey, clinical and/oradministrative claims data about patients who would have been candidatesfor the adherence program, plus filled prescriptions data to allow forcalculation of actual adherence after initiation of the medicationtherapy of interest. It will be understood that the data sources mayvary and may include other example data, such as, for example,administrative claims, electronic medical records, lab results, patientsurveys, socio-demographic detail, consumer purchasing data, etc. Itwill also be understood that different and multiple sources of data maybe used to determine any number of independent variables for use indeveloping the predictive function described below.

The historical patient data 210 is analyzed and used during setup 220 todefine certain variables 225, 230 and 235, for example, which may beused to determine a prediction function 280. For example, certain timeperiods 225 may be defined to assist in the extraction of variousvariables. Time periods of interest 225 may include, for example, aninception window or range of dates between filled prescriptions for thetarget medication which may be used to identify candidate patients forthe adherence program. An index date for each patient which reflects thedate of the first filled prescription for the target medication duringthe inception window may also be defined. It may also be useful todefine a look back period during which the pre-index information iscollected about each patient. A common example look back period is oneyear, but it will be understood that the look back period can range fromzero days to many years. In addition, a follow-up period may be defined.A common follow-up period may typically be one year, but the follow-upperiod may range from one day to many years.

It is next preferable to define a dependent variable 230, sometimes alsoreferred to as the measure to be predicted. In the medication adherenceexample, a common measure of medication adherence is the binary outcomeof a proportion of days covered being greater than or equal to eightypercent. In other words, this dependent variable 230 would be satisfiedif the patient obtained sufficient prescriptions to have the medicationon hand for at least eighty percent of the days in the follow-up period.It will be understood that definitions of adherence may vary and thatthe definition set forth above made by way of illustrative non-limitingexample. Other examples may include, proportion of days covered,medication possession ratio, discontinuation, etc. Additionally,threshold values may likewise vary, e.g., >=80%; >=70%; >=60%, etc. Withthe dependent variable 230 defined, it may then be useful to define anumber of independent variables 235.

Independent variables 235, may be developed based on published studiesof factors associated with adherence in a particular therapy area. Thesemay, for example, fall into three broad category areas. One broadcategory area may be, for example, attributes of the patient, e.g., age,sex, county of residence, health status and prior health careutilization. Another broad category may include, for example, attributesof the target drug regimen, e.g., specific drug, strength, quantitydispensed, cost, etc. A third broad category may include, for example,attributes of the health care system, e.g., prescriber's specialty,number of pharmacies used, health plan design, etc.

Independent variables 235 may include variables known to be predictiveof adherence and may include variables not known to be associated withadherence, but which can be rapidly tested using data mining methods toderive these from the patient data itself. For example, software runningon a computer system may be used to automatically create independentvariables. These variables generally may relate to the presence/absenceand frequency of all possible drugs, diagnoses and procedures in thepatient look-back period. Survey data may also be included in theprovided data and all possible responses may also be included. It willbe understood that different and multiple sources of data may be used todetermine any number of independent variables for use in developing thepredictive function.

A resultant data file 250 is generated to include the setup variables220 that are generated as described above. Patient data files may beaugmented and restructured to provide a common data structure for theresultant data file 250 in order to more efficiently process the datacontained in the resultant data file 250. The resultant data fileincludes information for each patient of interest from the historicalpatient data files 210 and include the setup variables 220 discussedabove.

Once the resultant data file 250 is created, it is provided to a furthermodel setup procedure 260, that will result in a prediction function 280that is then applied to candidate data to produce a patient-specificscore, in this case an adherence score. Creation of the predictionfunction 280 is discussed in more detail herein. In general, theresultant data file is analyzed using multiple statistical methods todevelop the best predictive function when tested and validated againstthe historical patient data in view of the fact that actual adherencecan be determined with respect to the historical patient data. As aspecific example, the resultant data file 250 may be divided into twoparts, a “training” data file 265 and a “validation” data file 270. Thesystem may then use, for example, multiple statistical methods 275,including, for example, any one or more of the following: logisticregression, random forests, classification and regression trees (CART),stacking, boosting, or the like, on the training data 265. Thesestatistical methods may generally be combined, and as such, be referredto as ensemble methods 275 for determining or creating a model orpredictive function based on the training data 265 that will yieldhighly predictive results. For example, as noted above, the resultantdata file 250 may be partitioned into two parts, the “training” data 265and the “validation” data 270 as described above. For the purposes ofexample, the resultant data may be randomly partitioned so that eightypercent (80%) are the “training” data 265 and the remaining twentypercent (20%) of the resultant data are in the “validation” data 270set. It will be understood that any statistically proper partitioningmay be selected based on the type of analysis and regression to beapplied to the data. The models or predictive functions are developedand tested using the training data 265 over multiple statistical methodsas discussed above (e.g., ensemble methods), and then testing thepredictive function against the validation data 270, which is alsocommonly referred to as held-out data. A predictive function that isderived from the training data 265 may then be applied to the validationdata 270, and the predictive function that is determined to perform beston the validation data 270 is selected as the predictive function to beapplied to the candidate patient data as described below. It will beunderstood that any number of other possible statistical methods may beused to generate the resulting prediction function, and that the systemand method disclosed is not limited to the particular examplestatistical methods described herein. In this manner, the independentvariables or predictors are used to predict the dependent variable usingthe predictive function 280 created on the basis of the historicalpatient data 210.

FIG. 7 is an illustrative block diagram of a value of future adherenceengine 300. As explained above, the value of future adherence engine 300can receive a probability score for each patient from the predictionengine 200 in which the value of future adherence engine 300 generates ascore associated with the value related to recommending intervention fora particular patient. The value of future adherence engine 300 can havea patient selection unit 310 which is used to select one or morepatients for analysis and a historical data analysis unit 320 which iscapable of applying historical/medical data of a patient in the costreduction analysis. The engine 300 can also have a cost analysis unit330 which can use the data from the historical data analysis unit 320 indetermining the cost of adherence, non-adherence, and cost reduction foreach patient as well as the probability of the patient converting fromnon-adherence to adherence. These factors can be used by the costanalysis unit 330 to generate the overall VFA score for a particularpatient.

The engine 300 can also be configured to have a user interface 340allowing one or more users to manipulate and view the data. An exampleuser interface is shown in FIGS. 1 and 2.

FIG. 8 shows an illustrative schematic block diagram of elements of acomputing system that may be used to perform functions associated withan example embodiment, which illustrates the basic requirements of sucha computer system 500. In FIG. 8, a bus 580 interconnects a processor510 with various hardware, firmware and software elements including, forexample a memory 520 which may be used to store historical and candidatepatient data as well as patient-specific patient-level data generated bythe example health care management system described herein. Moreover, itwill be understood that this memory is not necessarily integrated withthe computing system 500, but may be operatively coupled to the systemin any manner, including, for example, via a secured cloud, dedicatedlinks, the Internet, or the like.

The computer system 500 may also include a program memory 530 containingvarious instructions or application software that may be used to operatethe processor 510 and to process data, including, for example,machine-level code to run the basic operations of the processor as wellas software for implementing the illustrated health care managementsystem. It will be noted that the program memory 530 may also beintegrated in whole or in part with the processor 510 and is notnecessarily a separate element as shown in the drawings. The computersystem 500 may further include several interfaces that enable variousinteractions with the system 500. For example, a user interface 540 isprovided that allows operators to program the system 500 as well as toenter and manipulate data, and to extract information that may be storedin the memory 520 or other databases connected to the system 500. Theuser interface 540 may be, for example, in the form of a display andassociated input/output devices, such as, for example, a keyboard,mouse, gesture pad, or the like (not shown).

The system 500 may also include a communications interface 560 thatprovides connections for allowing the system 500 to receive and transmitinformation to and from external sources via various communicationslinks, including, for example, the Internet, an electronic healthrecords system, dedicated links, secure clouds, or the like. Forexample, the communications interface 560 may be used to receivehistorical patient data and candidate patient data or patient-levelfiles generated at another system or site. It is also contemplated thatthe system 500 may include peripheral devices 570, such as, for example,external memory, a printer, etc. While an example general computingsystem 500 has been described herein, it will be appreciated that thoseskilled in the art would be able to devise any suitable computing systemto achieve the objects and features described herein with respect to thedisclosed example health care management system.

As described above, the technology aims to achieve increased patientadherence to selected medication regimens and improvements in otherquality and efficiency measures in defined patient populations. Thetechnical field is health care and health care data analytics. Thetechnology helps facilitate efficient population-level improvements inmedication adherence and other health care outcomes. The technologyleverages the use of patient-level predictions about future health careoutcomes to inform the design and delivery of patient engagementactivities.

The technology establishes the basis for innovative, prediction-drivenperformance improvement programs in health care that have the potentialto improve the prevalence and performance of health care financial bonusprograms for health care professionals designed to achieve targetedimprovements in health care outcomes, including medication adherencecommensurate with the value that those very targeted improvements createto sponsors of such programs. The technology constitutes the coreenabler of new products that support health care improvement programsusing financial incentives to encourage new and/or better informedactions by health care professionals to engage patients in new ways,including in taking their medications consistently as prescribed.

It should be appreciated that the VFA score for each patient is notlimited to a single therapy and envisions covering multiple therapies.Likewise, the VFA score may be assigned to each patient for each therapyand the VFA scores may be combined to create a total score (i.e.,showing the population score/value). Also, the VFA scores may becombined for a practice showing the overall VFA score for the totalpatient population in the practice.

It should also be appreciated that the source for the medical historydata may come from a variety of resources including, but not limited to,medical claims data, pharmacy data, and/or survey data. The system isalso configured so that the cost component of the VFA score is maximizedwhile limiting the number of variables needed from pharmacy data whencreating the cost table (i.e., no medical claims used in the costtable). Of course, these advantages are non-limiting and the systemprovides a number of different advantages over the conventionaltechnology.

For purposes of explanation and non-limitation, specific details are setforth, such as particular nodes, functional entities, techniques,protocols, standards, etc. in order to provide an understanding of thedescribed technology. It will be apparent to one skilled in the art thatother embodiments may be practiced apart from the specific detailsdescribed below. In other instances, detailed descriptions of well-knownmethods, devices, techniques, etc. are omitted so as not to obscure thedescription with unnecessary detail. Individual function blocks areshown in the figures. Those skilled in the art will appreciate that thefunctions of those blocks may be implemented using individual hardwarecircuits, using software programs and data in conjunction with asuitably programmed microprocessor or computer, using applicationsspecific integrated circuitry (ASIC), and/or using one or more digitalsignal processors (DSPs). The software program instructions and data maybe stored on computer-readable storage medium and when the instructionsare executed by a computer or other suitable processor control, thecomputer or processor performs the functions. Although databases may bedepicted as tables below, other formats (including relational databases,object-based models, and/or distributed databases) may be used to storeand manipulate data.

Although process steps, algorithms or the like may be described orclaimed in a particular sequential order, such processes may beconfigured to work in different orders. In other words, any sequence ororder of steps that may be explicitly described or claimed does notnecessarily indicate a requirement that the steps be performed in thatorder. The steps of processes described herein may be performed in anyorder possible. Further, some steps may be performed simultaneouslydespite being described or implied as occurring non-simultaneously(e.g., because one step is described after the other step). Moreover,the illustration of a process by its depiction in a drawing does notimply that the illustrated process is exclusive of other variations andmodifications thereto, does not imply that the illustrated process orany of its steps are necessary to the technology, and does not implythat the illustrated process is preferred.

Various forms of computer readable media/transmissions may be involvedin carrying data (e.g., sequences of instructions) to a processor. Forexample, data may be (i) delivered from RAM to a processor; (ii) carriedover any type of transmission medium (e.g., wire, wireless, optical,etc.); (iii) formatted and/or transmitted according to numerous formats,standards or protocols, such as Ethernet (or IEEE 802.3), SAP, ATP,Bluetooth, and TCP/IP, TDMA, CDMA, 3G, etc.; and/or (iv) encrypted toensure privacy or prevent fraud in any of a variety of ways well knownin the art.

While the technology has been described in connection with what ispresently considered to be the most practical and preferred embodiment,it is to be understood that the technology is not to be limited to thedisclosed embodiment, but on the contrary, is intended to cover variousmodifications and equivalent arrangements.

The invention claimed is:
 1. A system, comprising: a processor; and amemory configured to store computer readable instructions that, whenexecuted by the processor, cause the system to: generate a list ofcandidates using, at least, medical history data; calculate one or morevalues associated with medication adherence for each candidate in thelist of candidates, wherein calculating the one or more values includes:determining a probability of non-adherence for each candidate in thelist of candidates, determining a probability of conversion fromnon-adherence to adherence for each candidate in the list of candidates,and determining a cost reduction for each candidate, in the list ofcandidates, when the candidate is considered to be adherent; calculate ascore for each candidate by combining the probability of non-adherence,for each candidate, by the probability of conversion from non-adherenceto adherence, for each candidate, and further combining the costreduction for each candidate when the candidate is considered to beadherent; apply the calculated score to each candidate; and generate auser interface for display that includes, at least, an ordered listingof each candidate, where each candidate in the ordered listing isdisplayed in association with an indication of medication adherence anda value associated with the score and corresponding to possible futureadherence to at least one medication for each candidate.
 2. The systemof claim 1, wherein the system is further configured to: obtain datapackets including, at least, the medical history data including one ormore prescription drugs associated with the one or more candidates; andcreate a resultant data file using the medical history data for the oneor more patients.
 3. The system of claim 1, wherein the indication ofmedication adherence, included in the user interface generated fordisplay, provides an indication of at least one health condition relatedto the candidate and a number of days that have passed between a currentdate and a date that a prescription related to the health conditionshould have been refilled.
 4. The system of claim 3, wherein theindication of medication adherence, included in the user interfacegenerated for display, provides an alert indicating that theprescription should be refilled.
 5. The system of claim 1, wherein eachcandidate in the ordered listing is further displayed with a costassociated with intervention in addition to the displayed value.
 6. Thesystem of claim 1, wherein the system is further configured to:determine one or more interventions available for each candidate; assigna cost of each intervention of the one or more interventions availablefor each candidate; and enable selection of a cost effectiveintervention by comparing at least the calculated score to the cost ofeach intervention.
 7. The system of claim 1, wherein the system isfurther configured to: determine a budget for participating in the oneor more interventions; and modify the budget when an intervention in theone or more interventions is selected for a candidate.
 8. The system ofclaim 1, wherein determining the probability of non-adherence for eachcandidate includes: identifying pharmacy claims for each candidate overa time period; computing variables related to therapies and/ordemographic information for each candidate; and applying the computedvariables and the pharmacy claims to a predictive model to generate theprobability of non-adherence.
 9. The system of claim 1, whereindetermining the probability of conversion from non-adherence toadherence for each candidate includes: identifying pharmacy claims foreach candidate over a time period; creating a profile for each candidatebased on characteristics determined from evaluation experienceassociated with the respective candidate; and assigning a conversionrate to each candidate in the associated profile of the candidate andlooking-up the conversion rate using the associated profile.
 10. Thesystem of claim 1, wherein determining the cost reduction for eachcandidate includes: identifying pharmacy claims for each candidate overa time period; creating or updating a profile for each candidate basedon specified research and modeling factors; and assign the costreduction to each candidate based on information associated with theprofile of the candidate.
 11. A method for determining a value of futureadherence, comprising: at an information processing system having atleast a processor and a memory: generating a list of candidates using,at least, medical history data; calculating one or more valuesassociated with medication adherence for each candidate in the list ofcandidates, wherein calculating the one or more values includes:determining a probability of non-adherence for each candidate in thelist of candidates, determining a probability of conversion fromnon-adherence to adherence for each candidate in the list of candidates,and determining a cost reduction for each candidate, in the list ofcandidates, when the candidate is considered to be adherent; calculatinga score for each candidate based on, at least, (a) the probability ofnon-adherence, for each candidate, (b) the probability of conversionfrom non-adherence to adherence, for each candidate, and (c) the costreduction for each candidate when the candidate is considered to beadherent; applying the calculated score to each candidate; andgenerating a user interface for display that includes, at least, alisting of each candidate, where each candidate in the listing isdisplayed in association with a value corresponding to the score andcorresponding to possible future adherence to at least one medicationfor each candidate.
 12. The method of claim 11, wherein the userinterface further includes an indication of medication adherencedisplayed in association with each candidate.
 13. The method of claim12, wherein the indication of medication adherence, included in the userinterface generated for display, provides an indication of at least onehealth condition related to the candidate and a number of days that havepassed between a current date and a date that a prescription related tothe health condition should have been refilled.
 14. The method of claim13, wherein the indication of medication adherence, included in the userinterface generated for display, provides an alert indicating that theprescription should be refilled.
 15. The method of claim 11, whereineach candidate in the listing is further displayed with a costassociated with intervention in addition to the displayed value.
 16. Asystem, comprising: a processor; a communications interface; and amemory configured to store computer readable instructions that, whenexecuted by the processor, cause the system to: obtain medical historydata from one or more information processing devices; generate a list ofcandidates using, at least, the medical history data; calculate valuesassociated with medication adherence for each candidate in the list ofcandidates, wherein calculating the values includes: determining aprobability of non-adherence for each candidate in the list ofcandidates, determining a probability of conversion from non-adherenceto adherence for each candidate in the list of candidates, anddetermining a cost reduction for each candidate, in the list ofcandidates, when the candidate is considered to be adherent; calculate ascore for each candidate based on the calculated values associated withmedication adherence; apply the calculated score to each candidate; andgenerate a user interface for display that includes one or more patientsand values associated with the calculated score.
 17. The system of claim16, wherein the score for each candidate is calculated by combining theprobability of non-adherence, for each candidate, by the probability ofconversion from non-adherence to adherence, for each candidate, andfurther combining the cost reduction for each candidate when thecandidate is considered to be adherent.
 18. The system of claim 16,wherein the user interface further includes a listing of each candidate,where each candidate in the listing is displayed in association with avalue corresponding to the score and corresponding to possible futureadherence to at least one medication for each candidate.
 19. The systemof claim 18, wherein the user interface further includes an indicationof medication adherence displayed in association with each candidate.20. The system of claim 19, wherein the indication of medicationadherence, included in the user interface generated for display,provides an indication of at least one health condition related to thecandidate and a number of days that have passed between a current dateand a date that a prescription related to the health condition shouldhave been refilled.